HYPOADKEOTA 321 



The possible relation of the marked prostration following an attack 

 of influenza to suprarenal insufficiency has been the subject of considerable 

 discussion. Autopsy records appear to indicate that lesions in the glands 

 are present in a large proportion of the fatal cases. Wolbach regards the 

 minor acute lesions which are constantly found in the cortex in influenzal 

 cases as not unlike those found in many infectious diseases, viz., the dis- 

 appearance of the lipoid content and focal necroses. The more extensive 

 lesions, such as hemorrhages, he attributes to secondary infection, usually 

 with the streptococcus hemolyticus. In a special study of the pathology of 

 epidemic influenza, Klotz observed changes in the suprarenal gland in 14 

 instances of 32 autopsies; these changes consisted of cloudy swelling of 

 the cortex, occasionally small petechial hemorrhages, and the almost com- 

 plete disappearance of the cholesterin bodies. This writer believes that 

 there is evidence to show that in influenza the suprarenal gland does not 

 function in a normal fashion, and that the storage of cholesterin esters does 

 not take place. Cowie and Beaven have made a special investigation of 

 the clinical evidence of the involvement of these glands in influenza and 

 influenzal pneumonia, as a result of which they believe that the occurrence 

 of suprarenal dysfunction is indicated by the presence of the cardinal 

 symptoms of asthenia and hypotension, and by the characteristic rise of 

 blood pressure following epinephrin injection; and further, that the pro- 

 longed blood sugar curve following the injection of epinephrin, and also 

 following the ingestion of glucose is indicative of an endocrin disturbance 

 in influenza. 



The occurrence of an anusually severe form of hypoadrenia was com- 

 monly observed among soldiers, during the war, in the course of various 

 infections, such as typhoid, malaria, epidemic icterus, and other infec- 

 tions. Pende(fr) has offered an explanation of this severe type on the sup- 

 position of a pre-existing glandular exhaustion, due to excessive war 

 fatigue (Sergent), and possibly in some instances to long-felt emotions 

 (Cannon). 



Several writers, in particular the French clinicians, have attributed 

 the alarming symptoms (vomiting, headache, fever, profound depression, 

 vertigo, and epigastric or lumbar pains) which sometimes follow anti- 

 typhoid, and other preventive vaccinations, to a sudden suprarenal insuffi- 

 ciency (Sergent (a), Satre, and Loeper (a)). Other observers have at- 

 tempted to explain, on a similar basis, the occasional occurrence of the 

 so-called "nitroid crises" following the administration of arsphenamin 

 (Beeson, Monziols and Collignon). No convincing evidence has been 

 offered, however, in substantiation of this hypothesis. 



The epinephrin content of the medulla, as well as the cholesterol con- 

 tent of the cortex, in various infectious diseases, has been investigated 

 by a number of observers. In the majority of cases studied, a reduction 

 in the epinephrin content has been demonstrated (Lucksch(c), Comes- 



